Registration Forms

Registration Forms

2 Shoes Farm Camps

Registration Form for 2023

Weekly Camps $330. 

With $100. non-refundable deposit. 

Mini Camps $275.

With $100 non-refundable deposit.

Please fill out and e-mail back to 2 Shoes Farm or use your browser's print option to print this form. For siblings can be filled out on one form. There must be individual releases filled out for each child you are registering.  Sign both registration and participation releases, e-mail, or bring both signed pages with your child on the first day of Farm Camp.

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*Child’s name: ____________________________________

Age: ____     Date of Birth: __________     

 Last School Grade: ______

Parent/Guardian Name: _____________________________________

E-mail Address: _____________________________________

Cell number:______________________________

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Farm Camp Dates

Please select: 

June    5 - 9 ______                         

June  12 - 16 _____

June  26 - 30 _____

July   5, 6, 7 ______ Mini Camp

July   10 - 14 _____

July   17- 21  _____ 

Adult dropping off and picking up:  ______________________________________

Relationship to child: ______________________________________

(Please include any important drop-off or 

pick-up instructions.) _____________________________________

_____________________________________

_____________________________________

_____________________________________ 

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*Payment: Cost: Half deposit required upon registration. Balance due the first day.  *For any reason camp should be canceled deposits will be refunded.

*Payment through Check, Cash or

 Pay-Pal:LeslieStevens@Pocoscowgirl

*Release for photos to be used on the website and social media pages.

Yes____ my child may be photographed and used for media

No ____ my child may not be photographed and used for media

Popsicles _____

Pizza.       ______

*Allergies/Medical Information/other ______________________________________________

EpiPen?  Yes or No:

______________________________________

Directions:_____________________________

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Benadryl? Yes or No:   Directions:_____________________________

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Dr. Signed Medical Action Plan? Yes or No:  __________________________________ 

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Any important information about your child we should know?____________________________________

_________________________________________

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*Emergency Release for (Child’s name): _________________________________________.

In the case of an emergency and I am not available the supervising teacher has my permission to seek medical help from 911 and be transported to: ___________________________________

                  (Name of hospital)  

(We use) Northside Forsyth/Canton or 

Children’s Health Care of Atlanta.  

______________________________________

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Agreement of Release & Waiver of Liability

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THIS AGREEMENT made and entered into on this ________ day of ______ 2023. Between______________________________(student) and/his or her legal Guardian, ________________________________, and Leslie M. Stevens, doing business at 2240 Yellow Creek Road, Ball Ground, GA  30107, (the “Premises”).

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The student and/or guardian understands and agrees to assume all risk, loss, damage, expense, claim, risk of injury, death, illness (ex.communicable diseases such as MRSA, influence, and COVID-19).

Disability or any other occurrence that would be considered a “loss” incurred by Student or Student’s guest while on the Premises or while handling or riding any horses or other animals on the Premises, or of the Premises, but while under supervision of Leslie M. Stevens. Student and/or guardian agree to indemnify, defend and hold Leslie M. Stevens harmless from any and all claims, damages, expenses, judgments, fines, impositions, fees, assessments, taxes, awards, or costs, including attorneys’ fees, which arise out of or in connection with the presence or action of any horse on the Premises or elsewhere, or any act or omissions of the student, the Guardian, or Leslie M. Stevens, whether on the Premises or elsewhere.  

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WARNING

UNDER GEORGIA LAW, AN EQUINE ACTIVITY SPONSOR OR EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES PURSUANT TO TITLE 4, CHARTER 12 OF THE OFFICIAL CODE OF GEORGIA ANNOTATED.

________________INITIALS IN WITNESS WHEREOF, the parties hereto have executed this Agreement___________________________.

By:__________________________________Student/Guardian    

Address:  ________________________________.

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Leslie Stevens

2240 Yellow Creek Road

Ball Ground Ga 30107